George W. Crile, Ohio's first neurosurgeon, and his relationship with Harvey Cushing

2005 ◽  
Vol 103 (2) ◽  
pp. 378-386 ◽  
Author(s):  
Narendra Nathoo ◽  
Frederick K. Lautzenheiser ◽  
Gene H. Barnett

✓ Much has been written about Harvey Cushing, his contributions to neurosurgery, and his relationship with many of his contemporaries. Nevertheless, there is no independent report documenting his relationship with Ohio's first neurosurgeon, George W. Crile. Crile's role as a neurosurgeon is limited to the late nineteenth and early twentieth centuries, and he is best remembered for other accomplishments. Father of physiological surgery, pioneering surgeon, innovator, inventor, soldier, and the principal founder of the Cleveland Clinic Foundation, Crile lived during the golden era of surgery, when the discipline was evolving from a crude and chancy art to an applied science. Crile achieved distinction by performing and describing the first successful radical neck dissection for head and neck cancers and the first successful direct human-to-human blood transfusion. He helped introduce the measurement of blood pressure during surgery, first used cocaine for regional anesthesia in the US, proposed “anoci-anesthesia” to prevent shock during surgery, helped establish one of the first nurse anesthetist schools, and invented the Crile forceps and the pneumatic suit, which was the forerunner to the aviator's antigravity suit. He was a founding member of the American College of Surgeons, its second president (1916–1917), and chairman of the Board of Regents (1913–1939). Crile was a teacher, lecturer, and author who published more than 400 papers and 24 books. In this report the authors trace the relationship between Crile and Cushing from their initial competition for a staff surgeon's position to their common interest in blood pressure, and their roles in the American Ambulance in France and later in World War I.

2002 ◽  
Vol 96 (6) ◽  
pp. 1139-1146 ◽  
Author(s):  
William B. Borden ◽  
Rafael J. Tamargo

✓ George J. Heuer was a pioneer in neurosurgery at The Johns Hopkins Hospital in the early 20th century; he trained under Harvey Cushing and acted as a mentor to Walter Dandy. In his early career, Heuer focused on research and clinical work in the field of neurosurgery and temporarily led the neurosurgery section at Johns Hopkins. One of his most important contributions to neurosurgery was the modern frontotemporal craniotomy. This elegant craniotomy, which initially was used to approach chiasmal tumors, developed into the modern frontosphenotemporal craniotomy, which neurosurgeons use to approach numerous tumors as well as most aneurysms. Although Dandy is frequently credited with inventing this operation, his article detailing the new approach clearly attributes its origin to Heuer, who was serving in World War I when the new technique was presented. Although he had hoped to lead the neurosurgical section at Johns Hopkins permanently, he returned from military service to find that Dandy had been appointed to this position. Heuer subsequently advanced to a distinguished career in general surgery as the chairman of surgery at two institutions, and was known for his contributions to surgical education. Throughout his academic years, Heuer continued to operate on the nervous system and to perform spinal cord and peripheral nerve surgery. He played an important role along with Cushing and Dandy in the creation of neurosurgery as a specialty, but he is rarely given credit for this accomplishment. The authors describe Heuer's contributions to neurosurgery as well as his distinguished surgical career.


Radiology ◽  
1944 ◽  
Vol 42 (6) ◽  
pp. 600-600

1984 ◽  
Vol 61 (6) ◽  
pp. 1009-1028 ◽  
Author(s):  
Lindsay Symon ◽  
Janos Vajda

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.


2000 ◽  
Vol 92 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Helene Benveniste ◽  
Katie R. Kim ◽  
Laurence W. Hedlund ◽  
John W. Kim ◽  
Allan H. Friedman

Object. It is taken for granted that patients with hypertension are at greater risk for intracerebral hemorrhage during neurosurgical procedures than patients with normal blood pressure. The anesthesiologist, therefore, maintains mean arterial blood pressure (MABP) near the lower end of the autoregulation curve, which in patients with preexisting hypertension can be as high as 110 to 130 mm Hg. Whether patients with long-standing hypertension experience more hemorrhage than normotensive patients after brain surgery if their blood pressure is maintained at the presurgical hypertensive level is currently unknown. The authors tested this hypothesis experimentally in a rodent model.Methods. Hemorrhage and edema in the brain after needle biopsy was measured in vivo by using three-dimensional magnetic resonance (MR) microscopy in the following groups: WKY rats, acutely hypertensive WKY rats, spontaneously hypertensive rats (SHR strain), and SHR rats treated with either sodium nitroprusside or nicardipine. Group differences were compared using Tukey's studentized range test followed by individual pairwise comparisons of groups and adjusted for multiple comparisons.There were no differences in PaCO2, pH, and body temperature among the groups. The findings in this study indicated that only acutely hypertensive WKY rats had larger volumes of hemorrhage. Chronically hypertensive SHR rats with MABPs of 130 mm Hg did not have larger hemorrhages than normotensive rats. There were no differences in edema volumes among groups.Conclusions. The brains of SHR rats with elevated systemic MABPs are probably protected against excessive hemorrhage during surgery because of greater resistance in the larger cerebral arteries and, thus, reduced cerebral intravascular pressures.


2002 ◽  
Vol 96 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
Rupert Kett-White ◽  
Peter J. Hutchinson ◽  
Pippa G. Al-Rawi ◽  
Marek Czosnyka ◽  
Arun K. Gupta ◽  
...  

Object. The aim of this study was to investigate potential episodes of cerebral ischemia during surgery for large and complicated aneurysms, by examining the effects of arterial temporary clipping and the impact of confounding variables such as blood pressure and cerebrospinal fluid (CSF) drainage. Methods. Brain tissue PO2, PCO2, and pH, as well as temperature and extracellular glucose, lactate, pyruvate, and glutamate were monitored in 46 patients by using multiparameter sensors and microdialysis. Baseline data showed that brain tissue PO2 decreased significantly, below a mean arterial pressure (MAP) threshold of 70 mm Hg. Further evidence of its relationship with cerebral perfusion pressure was shown by an increase in mean brain tissue PO2 after drainage of CSF from the basal cisterns (Wilcoxon test, p < 0.01). Temporary clipping was required in 31 patients, with a mean total duration of 14 minutes (range 3–52 minutes), causing brain tissue PO2 to decrease and brain tissue PCO2 to increase (Wilcoxon test, p < 0.01). In patients in whom no subsequent infarction developed in the monitored region, brain tissue PO2 fell to 11 mm Hg (95% confidence interval 8–14 mm Hg). A brain tissue PO2 level below 8 mm Hg for 30 minutes was associated with infarction in any region (p < 0.05 according to the Fisher exact test); other parameters were not predictive of infarction. Intermittent occlusions of less than 30 minutes in total had little effect on extracellular chemistry. Large glutamate increases were only seen in two patients, in both of whom brain tissue PO2 during occlusion was continuously lower than 8 mm Hg for longer than 38 minutes. Conclusions. The brain tissue PO2 decreases with hypotension, and, when it is below 8 mm Hg for longer than 30 minutes during temporary clipping, it is associated with increasing extracellular glutamate levels and cerebral infarction.


AI Magazine ◽  
2010 ◽  
Vol 31 (3) ◽  
pp. 13 ◽  
Author(s):  
Douglas Lenat ◽  
Michael Witbrock ◽  
David Baxter ◽  
Eugene Blackstone ◽  
Chris Deaton ◽  
...  

By extending Cyc’s ontology and KB approximately 2%, Cycorp and Cleveland Clinic Foundation (CCF) have built a system to answer clinical researchers’ ad hoc queries. The query may be long and complex, hence only partially understood at first, parsed into a set of CycL (higher-order logic) fragments with open variables. But, surprisingly often, after applying various constraints (medical domain knowledge, common sense, discourse pragmatics, syntax), there is only one single way to fit those fragments together, one semantically meaningful formal query P. The system, SRA (for Semantic Research Assistant), dispatches a series of database calls and then combines, logically and arithmetically, their results into answers to P. Seeing the first few answers stream back, the user may realize that they need to abort, modify, and re-ask their query. Even before they push ASK, just knowing approximately how many answers would be returned can spark such editing. Besides real-time ad hoc query-answering, queries can be bundled and persist over time. One bundle of 275 queries is rerun quarterly by CCF to produce the procedures and outcomes data it needs to report to STS (Society of Thoracic Surgeons, an external hospital accreditation and ranking body); another bundle covers ACC (American College of Cardiology) reporting. Until full articulation/answering of precise, analytical queries becomes as straight-forward and ubiquitous as text search, even partial understanding of a query empowers semantic search over semi-structured data (ontology-tagged text), avoiding many of the false positives and false negatives that standard text searching suffers from.


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